Long Reads

Witnessing Wuhan

China's success in "flattening the curve" of the COVID-19 epidemic has been held up as a model for the rest of the world to emulate. But what the world really needs to understand is that China's "victory" required massive sacrifices by doctors, nurses, and other health workers whose names we will never know.

AUSTIN – Dr. Li, a heart specialist at Wuhan No. 4 Hospital, spent the third week of March preparing for the reopening of the hospital’s general clinics, which closed on January 22, when No. 4 became a key facility for treating COVID-19 patients. After working for two months on the front lines of the coronavirus outbreak, Li is mentally and psychologically at a loss about what to do next. He can’t sleep or eat, he often feels dazed, and sometimes, seemingly out of nowhere, he weeps.

Li’s trauma stands in stark contrast to the image projected by China’s media, which is filled with articles and broadcasts glorifying the government’s response to the epidemic. Amid so much exultation, Li is increasingly reluctant to express fears or concerns to others around him. He has become a different man – one who understands that “life is fragile and weak.”

I met Li (his name has been changed to protect his privacy) online on January 23, the day the city of Wuhan was locked down. I am based in Texas, and my friends and I had set up a WeChat group to donate masks and personal protective equipment (PPE) to hospitals in and around Wuhan. Now that COVID-19 has escalated into a global pandemic, it has become increasingly important that the rest of the world understand what the doctors and nurses in Wuhan – several of whom I now call friends – experienced and are still experiencing. Insofar as China has achieved a “victory” over the coronavirus, it has come at a massive and lasting human cost.

The COVID Ward

My communications with Li were initially impersonal and focused on the logistics of getting PPE delivered to his hospital. But late on January 27, Li suddenly sent a message to the WeChat group saying that he needed to blow off some steam. I was still online, so I stayed to hear him describe the situation in Wuhan in vivid, heart-breaking detail.

That morning, after passing through several stages of disinfection, Li had walked into the hospital’s contamination zone, where he immediately encountered a man sprawled on the floor, masked, covered in a quilt, with a yellow-green complexion. Two steps away, another person lay prone on a bench, seriously ill and hardly breathing. A young man sitting next to him was yelling into a phone, seeking help. And many other patients were lying on the ground in the clinic hallway, gasping for breath. All around, patients and their family members stood, sat, or simply lay on the floor. According to Li, they had no expressions on their faces, as if they had become accustomed – or at least resigned – to their misery.

The floor was covered in garbage, blood, vomit, and sputum. The patients far outnumbered the medical personnel. Li saw two nurses in charge of intake and registration surrounded by patients' family members, some of whom knelt at their feet begging for help. Occasionally an ambulance arrived with still more patients. Looking outside, Li saw a seemingly endless line of people waiting at the hospital door, many of whom could support themselves only by leaning against the wall.

In the early days of the lockdown, Li told me, the number of outpatients coming to the clinic each day was in the thousands. People waited four or five hours just to sign in, then waited another four or five hours either to receive take-home medicine or to be admitted to an infusion room on the second floor, where they joined several hundred others waiting for available beds.

Some people collapsed while waiting; some, clearly, were near death. The hospital’s wards were so full that the corridors and doctors’ lounges had to be used for additional beds. All of these were filled, and remained so, because no one seemed to be recovering.

“There’s insufficient manpower, limited treatment, and scarce PPE,” Li told me. He struggled to explain why he couldn’t help these people. “I’m doing my best,” he said over and over. “What more could I have done?” I stayed chatting with him until it was time for him to go back to work.

Days of Panic

Two days later, on January 29, Li called me in a frenzy. While on duty that day, the family members of a recently deceased patient had attacked one of Li’s colleagues, ripping off his mask and shouting, “If we’re sick, we’ll be sick together. If we have to die, we’ll die together.” (The Chinese news outlet Caixin later reported on the incident.) Li was furious – his messages to the group bristled with exclamation marks.

But he was also exhausted. He told us that he almost couldn’t take any more. “For a long time, I have been psychologically prepared to be infected,” he told me, referring again to the lack of adequate PPE. But what he was not prepared for was the trauma of having to fend off patients who had been pushed to the edge of panic and despair. He had witnessed fellow doctors being cursed at, beaten, and dragged around the hospital hallways. He feared it was only a matter of time before he experienced the same treatment.

Li’s messages depicted a scene of continuing deterioration. More and more people were dying. But because PPE was so scarce, there were times when medical staff would not enter the wards even to carry away dead bodies. Li, sitting beside the corpses, tried to distract himself by mechanically writing prescriptions for those who were still alive. It was a living hell.

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In the early days of the lockdown, the local funeral home had gotten by with a van to transport corpses from the hospital. But soon enough, it needed a cargo truck. One day, after his shift, Li witnessed hospital workers putting corpses – he counted as many as seven or eight – into body bags and throwing them onto the truck bed.

The scene stayed with him. He couldn’t get it out of his head when he was awake. When he managed to sleep, he had nightmares. He was overcome by a sense of helplessness. While the state media were portraying health-care workers as heroes, he was devoting his time and energy to treating patients who would not recover. “We’re hardly heroic,” he says.

Li has continued to message and call me about once a week since our first long conversation. “I’ve been slowly improving,” he told me on March 11. Still, he continues to suffer from insomnia, and he is reluctant to tell friends and family in China how he’s really feeling.

The situation at work has taken another demoralizing turn. When the outbreak was raging, he explained, some of the hospital’s administrators cowered in their offices, too afraid to venture out into the wards. But now that commendations are being handed out, the bosses have been the first in line for bonuses. “It’s much more profitable to work in the financial industry,” he laments. “Do you think I might still have an opportunity to work in that profession?”

In the Trenches

Li is not alone in considering a career change. Another of my contacts, a 30-year-old nurse at Wuhan Changhang General Hospital, has also asked herself if she can keep going. Ms. Wang, as I’ll call her, was among the first to work in the hospital’s “fever clinic” when the outbreak began. From the beginning, she recounts, everything was in short supply, including not just PPE and medicine but even cafeteria provisions. She had to work, with little food or water, 12-hour shifts that started at 6:00 or 7:00 in the morning. When fatigue overcame her, she didn’t dare take off her protective gear. She simply leaned against a wall and slept with it on.

When the city shut down, Wang couldn’t get to work by bus, so she used a bike-share. But one morning, she rose at 05:00 and couldn’t find an available bike, so she walked to the hospital instead. On the way, feeling more desperate and frustrated than ever, she called me and asked, “Can you help us put out an appeal to give the frontline doctors and health-care workers a way out of this?”

Wang is optimistic and kind, but she does not hide her emotions. When a patient’s family gave her a small gift of tea and snacks, she was deeply moved. She also speaks her mind and is unafraid of people in authority. At the beginning of the epidemic, when Wuhan residents had yet to come to grips with the scale of the crisis, Wang bought Tamiflu – an antiviral used to treat influenza that has been administered to patients in Wuhan even though there is no scientific evidence that it is effective against COVID-19 – and gave it to relatives and friends, counseling them not to go out.

Then, when China’s State Council set up a hotline for reporting incidents of negligence in combating the outbreak, Wang immediately reported that her hospital’s leaders had concealed infections among the medical staff. Her best friend was among the earliest to contract COVID-19 and had been put into intensive care with respiratory and heart failure on January 23. In an attempt to ease Wang’s worries, the friend sent a photo of herself smiling behind her ventilator. But the gesture had the opposite effect. After seeing it, Wang told me, she felt even more terrified and desperate to avoid infection.

Even so, Wang continued to work, and just two days later – on January 25 – she started to cough. In a text message, she told me that a CT scan had identified a shadow on her right lung. I told her to rest. She said she couldn’t, because her hospital was short of nurses as it was.

Heal Thyself?

While serving on the front lines, Wang saw many of her colleagues break down and cry in the hospital’s lounge. She sent me a video of a nurse curled up in a corner weeping and proclaiming hysterically that she wanted to quit. I asked Wang what had happened to that nurse, but she told me that such episodes were common. As soon as a patient rang a call button, the nurses would pick themselves up and hurry back to the ward.

On January 27, Wang was diagnosed with a coronavirus infection. That judgment was based solely on her CT scan, even though the standard for confirming a coronavirus case at the time was to use a test kit. Within two weeks, China would formally loosen its criteria for counting cases, allowing for more diagnoses based on characteristic symptoms.

Wang and other infected colleagues were told to self-isolate at home. By late January, hundreds of her colleagues were in home quarantine or had been hospitalized. She and her husband sequestered themselves in separate bedrooms of their apartment. For weeks, Wang lived in fear, both for herself and for her loved ones, not least her four-year-old son, whom she had left with her in-laws.

Wang’s supervisor instructed her not to tell anyone she was infected. If someone asked, she was supposed to say “no,” to avoid sowing panic. By then, many hospitals and media outlets had received orders not to talk about the epidemic. On January 27, Wang told me that medical staff had been ordered to remain calm and collected in front of anyone who did not work at the hospital.

During her quarantine at home, Wang kept busy by connecting with various online volunteer organizations that were trying to deliver more PPE to her hospital. When her symptoms finally abated on February 27, she was given two diagnostic tests 24 hours apart, as protocol required. When they both came back negative, she immediately returned to work. “I was really scared this time,” she told me. “I didn’t know if I could do it again. I have a son. Now I realize I want a safer job.”

In March, the Chinese tech firm ByteDance (the parent company of the popular social-media app TikTok), offered CN¥100,000 ($14,100) to every medical worker who had been infected. Yet because Wang’s COVID-19 infection had never been confirmed by a test, she assumed that she would be ineligible for the reward. In any case, she told me that she was not interested in that kind of compensation. What she really wants is a post mortem investigation into “the government and hospital officials who covered up the outbreak.”

Far From Over

A final account of the COVID-19 crisis comes from a longtime friend whom I’ll call Jing. An anesthesiologist in the city of Shiyan, near Wuhan, Jing had never imagined that she would be working on the front lines of an epidemic. But by late February, she had no choice. The first wave of medical personnel had pushed themselves physically and psychologically to the limit, but the number of patients being admitted continued to rise.

In response, Jing’s hospital launched a training program to teach medical specialists in other fields how to treat coronavirus patients in a clinical setting. After her crash course, Jing was sent into the trenches. When I spoke to her on February 22, she admitted that when she first witnessed an ambulance bringing in a new COVID-19 patient, her immediate instinct was to turn and run. But she fought that impulse. As a health-care provider, her job was to help people, so she got to work. After her first day in the clinic, she cried long and hard.

As of early April, the epidemic appears to have been mostly contained in China. But Jing is wary of letting down her guard. She worries that discharge standards will be set too low, and she wonders if adequate testing has been conducted in places like prisons and nursing homes. Given the spread of the coronavirus globally, she also fears that a wave of new cases will be imported from overseas.

When I spoke to Jing on March 8, she told me that the higher-ups in her hospital do not share her sense of vigilance. On the contrary, they have been acting as if the battle already had been won. “While we are grateful to the people across the country, medical teams that came to support our Hubei, overseas Chinese, and civil society for their supplies,” she told me, “we have no thanks for our leaders or the government. This still isn’t over, and they’re already rushing to collect rewards for merit.”

As the full horror of the epidemic passes from the country of my birth to the country where I live, I want people to know about how bad things got in Wuhan. Watching people in my neighborhood ignore the calls for social distancing fills me with rage and dread. Everyone outside China must understand how much that country’s medical workers sacrificed to bring the outbreak under control.

More to the point, everyone must recognize that the campaign against COVID-19 is far from over, and that we will all be living under its shadow for a long time to come. While the number of confirmed cases in China is decreasing, and immediate fears of death may have eased, the scars from the outbreak’s peak will remain. And doctors, nurses, and other medical professionals, in particular, will continue to struggle with what they experienced. Their wounds will not heal soon.

This commentary is published in partnership with ChinaFile, the online magazine of the Asia Society’s Center on US-China Relations.

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Tracy Wen Liu offers a harrowing account of frontline doctors and health-care workers who fought to save lives when their hospitals in the virus-ravaged Wuhan were swamped with coronavirus patients in January. While China’s state-controlled media glorify their government’s response to the pandemic, its victory over Covid-19 came at a “massive and lasting human cost.” With people lying on the floor, waiting to die everywhere, health-care workers faced verbal and physical abuse from patients and their families. On April 4, China mourned the people who died of Covid 19, by observing a three-minute silence, bringing the nation to a halt. Although the event was a chance to pay respects to "martyrs" – the 14 medical workers who died battling the virus – yet those who have survived must come to terms with traumatic experiences. They made huge sacrifices, while “hospital’s administrators cowered in their offices, too afraid to venture out into the wards. But now that commendations are being handed out, the bosses have been the first in line for bonuses.”Through her interactions with doctors and nurses in Wuhan, she gives a first-hand account of their fear, anxiety, panic and chaos at the hospitals. Initially there was a shortage of masks and personal protective equipment (PPE) in and around Wuhan, and medical workers had to work under pressure and in an horrifying environment. They had lost count of the number of deaths, because the corpses had to be taken away in cargo trucks. China claimed it had 81,865 cases and 3.335 deaths. The death toll in Wuhan has stalled at a little over 2,500, but it could be much higher than official figures suggest. Yet something did not seem add up. Caixin, a Beijing-based publication known for political investigations, noted that one local crematorium in the city was operating for 19 hours a day and in just two days, 5,000 urns were delivered to the establishment. Foreign media outlets picked up on the details and extrapolated further, suggesting that as many as 42,000 could have died in Wuhan.Li Wenliang, a doctor in Wuhan who died of Covid-19 after being reprimanded by the authorities for attempting to warn others about the disease, and a series of critical stories by journalists on China’s slow response in the early days of the outbreak, prompted angry responses from those who saw them as an attack on China, accusing them of smearing the country’s reputation. While Western journalists had been kicked out of China for being critical of Beijing, Chinese reporters face other risks: At least 48 Chinese journalists were jailed last year.Although the pandemic is said be contained, the author does not believe that the nightmare is over. One anesthesiologist, who received a crash course before taking on coronavirus patients, worries that discharge standards are set too low, wondering “if adequate testing has been conducted in places like prisons and nursing homes. Given the spread of the coronavirus globally, she also fears that a wave of new cases will be imported from overseas.”Concerns that asymptomatic cases appeared to still be spreading in Wuhan, have not been shared by higher officials, who merely want to declare victory. “While we are grateful to the people across the country, medical teams that came to support our Hubei, overseas Chinese, and civil society for their supplies,” she told the author, “we have no thanks for our leaders or the government. This still isn’t over, and they’re already rushing to collect rewards for merit.”Indeed, the world is watching China closely, as many do not forget the ordeal they have gone through as a result of high human cost and economic hardships. They blame Beijing for covering up the danger of such a deadly virus, and proactively impeding a global response that might have prevented a worldwide contagion.

On 30 December 2019, Dr. Li Wenliang circulated to his private Wechat group, comprising his medical school classmates, regarding his concerns about SARs re-emerging, based on a report from Dr. Ai Fen, director of the emergency department at Wuhan Central hospital (original screenshots at http://www.bjnews.com.cn/feature/2020/01/31/682076.html). Unfortunately, both Dr. Ai and Dr. Li were incorrect - they thought Wuhan was facing a new strain of SARS.

I do not know when Dr. Ai issued her report, but within a week (5 January 2020) of Dr. Li raising his concerns in his private group chat, WHO already reported that China was undertaking contact tracing (https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/). This was done because of a suspicion of human-to-human transmission, although there was insufficient evidence at that time.

Hindsight makes us all experts, but I am curious to know what else China should, ought and could have done.

Yes, this is an interesting anecdote. Just like the incident is an interesting incident. It is a something to occupy one's time, as a long read. A formidable undescribable foe has been found to establish a unifying force to retaliate against. Some body has done a super job, what a unifying mechanism for a global population to focus against, especially considering the increasing limited means for some sort of survival. How far can a non-existent buck stretch forever? Pretty good strategy, depending who buys into the narrative. Or, perhaps depending on who is forced to buy into the narrative because that's the only game in town. The selling of relative truth has become the messaging of relative debt to the most people on earth. If you can't get them to buy into it willingly, force it down their throats. The next step is strategizing global food supplies, and of course water. Fight forward, and onward, upward, or downward!!!

Witness statements are not anecdotes. This is not a scientific study with a sampling strategy. There are times to make the political analysis foremost but in this case the political analysis is about the repressive authoritarian inflexibility and fear that rules China, not about global capitalism. If you compare the outward appearance of the resources fielded in Wuhan and the fact that Turkey is flying supplies to the US today, China looks like a country whose systems can deliver. Both countries are countries that treat life as disposable when power is uncomfortable. In responding to this article, however, to the resourcefulness of the reporter, the trust they established with the relevant medical staff in China, the truly terrifying situation those staff experienced, and the awful lasting mental legacy, are surely paramount.

Contrary to Western belief, the terrifying conditions reported here were known to a significant population in China. As an expat working in China, I can verify that a lot of information in this article was circulated in social media beyond the grasp of the censors. From the end of January, China incrementally locked down close to 60 million of its population, a number larger than many states in the EU. How is it, then, that the alarm bells ringing so discordantly in China became drowned out in the echo chambers of the West? The Western media wasted no opportunity in criticizing the unpalatable Chinese measures and trumpeting the unacceptable human and economic costs. Countries are free to pick and choose elements of China's approach to suit their own situation, but to insist there was insufficient notice about the seriousness of the situation is surely disingenuous.

The West has been very passive in the early stages and indeed, China's effective lockdown measures inspired the West to do so later on. However, saying that there was sufficient notice is absolutely inacurate. You have seen those testimonies circulating on social media that is true. But the problem lies there! They did not make it further than social media... WHO repeated EXACTLY the same narrative Chinese authorities were saying, at least until late January. Signs of the seriousness of the situation were there of course, and had western governments been smarter and more proactive, the situation would certainly be much better now. But let's be honest, had the information about the situation in Wuhan been more transparent from the start, thousand of lives in the world would have been spared.

On 5 January, WHO informed the world that the pathogen remained unknown, but reported that China was doing contact tracing. This is one of the protocols when there is suspicion of human-to-human transmission.

On 10 January, based on existing data coming out of China, WHO provided technical guidance on how to detect, test and manage potential cases. Crucially, this included advice to medical personnel to take the same prevention measures as treating MERS and SARS. Even when there was no clear evidence of human-to-human transmission, WHO advised medical professionals to address that risk.

This terrifying article confirms again that most essential weapon against this pandemic are the democratic liberties enshrined in the US Constitution which allow any citizen to sound the alarm without fear of being silenced by a corrupt government like the one currently in China.

While we in the US don't fear to be imprisoned, under the current (Trump) administration 'sound[ing] the alarm' may still cost you your career, as this weeks case of Captain Crozier shows: he was relieved of his command after an email was leaked, in which he sounded the alarm of COVID-19 cases on his ship and requested help.

Were we on a 'pursuit of happiness' before COVID-19? Or a 'pursuit of survival'? What else has the virus revealed in liberal democracies Ms Palacio? Their solidarity? State responsibility to take care of the most basic of needs of civil society? Their equality? Why such alarm about the Chinese and other Asian models? Maybe because they raise more fundamental questions than the trite 'life (whose?), liberty (whose?), and the pursuit of happiness (whose?)

Interestingly the Chinese government said that they sent 40 thousand nurses and doctors to help and that's it self 2 patients for 1 help you know simple math 82 thousand cases 40 thousand help...just some logical math

Thank you Tracy, for providing this insight and many thanks to Dr Li. Its a shocking picture on the front line of this crisis. The loss of so many unsuspecting people is tragic. Hopefully the hard found lessons will minimize pain and fear as this rolls on. How ever might we be able to thank these health-workers for all they have done and be subjected to?

This article makes plain the direct and implicit costs healthcare workers face as they do their job. Many in this workforce are now reconsidering their ability to stay in their profession, as profits are privileged over the lives of the people providing care. It is also no secret that the healthcare workforce is predominately women in the US and many other countries. There already exists a world-wide shortage of people wanting to enter the healthcare workforce. Now we know why. Physicians are particularly maldistributed geographically. Public healthcare workforce planning has to be prioritized in determining all future resource allocations.

Such anecdotes are very important for those who have not yet seen the peak of the pandemic. Maybe it does not contain a solution proposal, but it is important for our psychological preparation for what we are facing.

We need such anecdotal pieces to drive home the message of the human condition.I recalled war stories from the trenches as I read this.However, I was also reminded that wars were invariably fought because leaders believed the cause trumped the loss; generals and captain led the young to equally, if not worse aftermaths.With Covid19, we humans face a common foe, and it is not another human. Hope this most important lesson is our takeaway.

"I was also reminded that wars were invariably fought because leaders believed the cause trumped the loss." Interesting in these times you state " leaders believed the cause trumped the loss. As in Donald Trump.

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